Search The Knowledge

The RMT and Why You Should Carry A Tourniquet

Oct 17, 2019

Tourniquets have always been a necessity for the soldier and the law enforcement officer, not just for self care, but for buddy care and for citizen care. Since the boom of the civilian / law enforcement, 2A / training industry, there have been a lot of new tourniquets which have been released and this has caused a lot of commotion. Tourniquets, for some, are almost like being associated with a cult of some kind. Those who like NAR CAT tourniquets will argue with those who like TacMed SOF Tourniquets and everything in between.

I have had real world experience with several different types of tourniquets, various generations of CAT's and TacMed SOF's, as well as, the newly TCCC approved Ratcheting Medical Tourniquet (RMT). I have posted previously as to my experience with the CAT's and SOF-T's several times, in which I have broken both types (of various generations of each) in real world circumstances. Thankfully for those subjects who I was applying the TQ's on I had more than one on me and could effectively apply the second one. There were instances of a single tourniquet being on the precipice of breaking, the CAT's tourniquet being plastic would have the windlass bending and the SOF-T's metal parts would be deforming while the bleed was not being stopped completely. This occurred several times in my first hand experience and others were reported to me by other officers.

I have posted about my experience of a small framed female officer not being able to turn the metal windlass over a SOF-T to gain occlusion due to her lack of strength and the size of the subject's appendage. I had to get hands on and apply the tourniquet correctly. There have also been instances where one CAT or SOF-T did not stop the bleed. I knew that if I turned the windlass anymore that either one would break and I would have to start all over with another tourniquet. I have also been taught in numerous LE-specific and open enrollment medical trauma classes that CAT's and SOF-T's may require a second tourniquet to be applied above the first one if one does not occlude the subject's bleeding. In my personal opinion this is completely unacceptable as it requires people to carry two tourniquets for one application.

Many of you will know that I started posting about the RMT a few years ago, well before CoTCCC declared it was TCCC recommended earlier this year. I knew it would be TCCC recommended because of how effective of a tool it is, and I have been carrying RMT's since I was given the opportunity to test them myself. Since then, I have adopted them, so have many others in the LE / industry training world and those who have a lot of experience dealing with medical trauma have also been recommending them.

As you can see Bill Rapier of amtacshooting.com uses, and trains with, an RMT (top of his case). I gave Bill an RMT early on and he has done a lot of training with it. One of the biggest aspects of the RMT's is that the tourniquets are built around use, which means they are designed for training, as tools, and not one time use tourniquets like many others. A one time use tourniquet that costs as much as an effective tool like the RMT is a complete ripoff in my opinion.

Training is one of the most important aspects of being ready, and having tools which you can train with allow you to become more proficient. It is a process everyone has to go through, and with the RMT you quickly understand that this is one tourniquet which was designed specifically for learning and building confidence. With many other TQ's you simply cannot train with the one you carry, in fact those manufacturers specifically say that you should not do that due to possible failures. The RMT is designed for training and the actuator is designed for hundreds of thousands of clicks if not more. I have personally never seen or heard of one break through training, or real world use, without mechanical assistance against a hard surface. Find a medical class which covers tourniquet use and application, even if not tactical in nature, is an easy way to learn proper medical/tourniquet techniques. Check out bleedingcontrol.org for low (or no) cost courses which will help you understand training concepts and when you should employ the RMT (and other tourniquets) properly.

I want to reiterate that you need to train with your tourniquet, whatever that tourniquet may be. You should be confident in single hand application from various positions, either hand, applied to either leg or arm, to distal appendages and on other people. You should be as comfortable applying a tourniquet as you are to handling a firearm, it should be an ingrained unconscious competence skill set. This is extremely important as the first time you use a tourniquet on yourself, or another person, should never be the first time you are using that tourniquet.

As you saw in the above video demonstration of the RMT, a child can apply an RMT onto an adult to reach occlusion. This is extremely difficult to achieve with other tourniquets, especially windlass tourniquets. This means a child can effectively stop a massive hemorrhage on an adult through the use of the RMT, the ratcheting mechanism allows this to happen effectively. A child would likely not be able to effectively apply a windlass or non-ratcheting tourniquet onto an adult effectively due to the strength required in turning the windlass. The Pediatric RMT is specifically designed around child and animal (read K9) application, which can be self applied by a child (if training and understanding exist). Many other tourniquets on the market (save for the RATS, which I do not recommend) cannot apply to children or animals appropriately or effectively. This is something which many gloss over when researching a tourniquet. If you have children, your child should have a pediatric tourniquet in their backpack for school and they should know how to apply it to themselves, other children, which type to apply to adults, and why. As a parent you should have these tourniquets in your vehicles, and in packs on trips, yes you can fly with an RMT. Training your children and allowing them to carry a tourniquet gives them an added level of responsibility for themselves and others, this (along with a lot of good parenting) will help set the groundwork for a capable adult.

Something to consider is that if you have a child with a traumatic hemorrhage, or a distal appendage hemorrhage on an adult, you should always attempt to position a tourniquet about 2-3 inches above the (all/any appendage) bleeding site (per the Hartford Consensus/Stop The Bleed - page 11). The 1.5" or 2" RMT's may be too large to apply to an adult's wrist or lower (towards the wrist) forearm, so you may need to apply a pediatric RMT to an adult for this particular purpose. Of course if you do not have a pediatric RMT you can always apply a standard RMT to the forearm or the bicep, but always avoid joints (or joint space) when applying any tourniquet.

The number one reason to carry a tourniquet is that hemorrhage is the most preventable cause of death after traumatic injury. Unlike the majority of common acute life threats, hemorrhage is one of the few instances in which a well prepared bystander with minimal medical training can actually save a life. You never want to be in a position where all you can do is watch someone bleed out in front of you. -Medical Professional who has first hand experience with the RMT and working in an ER.

Carrying a tourniquet on your person is absolutely something you should make a habit of. Specifically because you are more likely to use a tourniquet than your pistol or blade, though you should be carrying them as well. You may come upon a vehicle accident where a person is bleeding or has a serious break that went through an artery, you may be at a sporting game when someone suffers a serious traumatic injury, you may work in a place with heavy machinery, or the like, and while they may have tourniquets in medical boxes on a wall somewhere, the fact is that the faster the application of a secure tourniquet, and transportation to a level 1 trauma hospital, the better off that person will be. Self reliance is also a very important aspect of this particular mindset, carrying your own tourniquet which you know how to use because you have trained with it numerous times allows you the confidence to apply a tourniquet to yourself, possibly saving your own life.

A good friend of mine, and early adopter of the RMT, was using an ax to cut down a tree when the ax bounced off the tree during a swing and decided it was going to nestle a few inches into his leg. He did not initially feel the pain but felt how warm his leg became, as if someone poured warm water on him. Well it was not water, it was blood, squirting out. This is about the time the average person would panic, scream, and probably bleed out to death, but thankfully he had his RMT in his pocket which he quickly and effectively applied. He drove himself to the hospital and the doctors were able to patch him right up.

This happened a few weeks ago and he is doing exceedingly well. He called me, to tell me about the circumstances and thanked his training, which he credits in keeping him from bleeding out. I made sure he received a new RMT to carry, even though all he needed to do is rinse off the one he applied to himself and continue to carry it, because that's how effective of a tool the RMT is.

As I documented in this post, I have ended up carrying a 1.5" RMT in a Mini-E-Med Gen2 from ICC. I have, however, carried the RMT folded (yes you can fold the RMT in half pretty easily without any functionality issues) with a ranger bands, you just need to place the bands on the ends (outside of the mechanism) so that you can rip it or flick it off easily. Some have used a PHLster flatpack to carry theirs in, you fold the RMT in half and then tie it down. It works well to this end. Otherwise, I carried the RMT for a year or so just folded in my pocket with the pull tab upward. I know Bill Rapier carries it straight in his front pocket or his side pocket depending on the pants. I prefer cargo pants for this particular reason. You can also carry inside an ankle first aid kit (AFAK), I still carry my Ryker AFAK everyday at work and I fold an RMT into one of the big pockets. Fits well, no issues on comfort or concealment. Pull tab upward allows me to pull it out with relative ease and apply as needed one handed. There are a lot of solutions to carrying which may apply to you one way or another. It can fold flat enough to be carried effectively as an EDC item.